ICU转出患者家属转科应激压力评估量表的构建及信效度检验

发布时间：2018-09-04 08:55

【摘要】：目的:初步编制符合我国国情的ICU转出患者家属转科应激压力评估量表,旨在为ICU医护人员识别及评估家属转科应激压力提供客观的评价工具。方法:(1)通过广泛文献回顾、对12名ICU转出患者家属进行半结构式访谈及参考国外相关评估工具构建量表理论框架,拟定量表条目池;(2)应用Delphi法对7名护理专家进行专家函询,计算问卷回收率、专家权威系数及各级指标的和谐系数,根据各条目的均值、标准差、变异系数对条目进行筛选,形成预调查量表;(3)使用预调查量表对重庆市4家三级甲等医院中心ICU 145名患者家属进行调查,采用经典测量理论下的离散趋势法、因子分析法、相关系数法及Cronbach’α系数法对条目进行筛选,形成终量表;(4)使用终量表对重庆市4家三级甲等医院中心ICU 186名患者家属进行正式调查,采用Cronbach’α系数进行信度分析,采用探索性因子分析及验证性因子分析法进行效度分析。结果:(1)初步构建的量表包括分离焦虑、环境改变、病情严重程度、护理模式改变、安全性、照顾能力自我效能感6个一级指标,30个二级指标。(3)使用Delphi法对7名护理专家进行2轮咨询,专家权威系数为0.83,两轮专家积极系数均为100%,2轮专家意见协调系数分别为:一级指标0.36、0.36,二级指标0.35、0.37,P值均小于0.05。通过对指标的筛选,结合专家意见,形成预调查量表,包括6个一级指标,25个二级指标。(4)预调查结果经过经典测量理论下的统计学分析,删除5个条目,形成终量表包含6个一级指标(转科分离焦虑、环境改变、病情危重程度、护理模式改变、转科过程安全性、照顾能力自我效能感),20个二级指标。(5)终量表的调查结果分析,量表总Cronbach’α系数0.882,探索性因子分析提取6个公因子,与量表6个维度一致,累积方差解释率72.226%,验证性因子分析模型的拟合情况:χ2/df=1.677,相对拟合指数=0.936,塔克-路易指数=0.921,近似误差均方根=0.061,拟合度优。终量表具有较好的信效度。结论:本研究构建的ICU转出患者家属转科应激压力评估量表经Delphi法专家咨询、预调查条目筛选后,能较全面的反应了ICU转出患者家属的心理压力特点,量表具有良好的信度和效度,适合于ICU转出患者家属转科应激压力的评估。
[Abstract]:Objective: to develop a stress assessment scale for family members of patients with ICU transferred out of hospital in order to provide an objective evaluation tool for identifying and evaluating the stress of family members transferred from ICU to hospital. Methods: (1) based on extensive literature review, 12 families of patients with ICU were interviewed in a semi-structured way, and the theoretical framework of the scale was constructed with reference to relevant evaluation tools abroad, and the pool of items was drawn up. (2) 7 nursing experts were interviewed by Delphi method. To calculate the questionnaire recovery rate, expert authority coefficient and harmony coefficient of all levels of indicators, according to the average, standard deviation, variation coefficient of each item to screen the items, (3) using the pre-survey scale to investigate the family members of ICU patients in four Grade 3A hospitals in Chongqing, adopting the discrete trend method based on classical measurement theory and factor analysis, Correlation coefficient method and Cronbach' 伪 coefficient method were used to screen items to form the final scale. (4) the final scale was used to investigate the family members of ICU 186 patients in four Grade 3A hospitals in Chongqing, and the reliability was analyzed by Cronbach' 伪 coefficient. Exploratory factor analysis and confirmatory factor analysis were used for validity analysis. Results: (1) the scale consisted of separation anxiety, environmental change, severity of illness, nursing mode change, safety, and so on. The self-efficacy of care ability was 6 first-degree indicators and 30 second-level indicators. (3) 7 nursing experts were consulted by Delphi method for 2 rounds. The expert authority coefficient is 0.83, the two rounds expert positive coefficient is 100 and two rounds expert opinion coordination coefficient is: the first class index is 0.36 / 0.36, the second class index is 0.35 / 0.37 / P < 0.05 respectively. Through the screening of indicators, combining with expert opinions, the pre-survey scale was formed, including 6 first-grade indicators and 25 second-level indicators. (4) after statistical analysis under classical measurement theory, 5 items were deleted. The formative final scale included 6 first-grade indexes (separation anxiety, environmental change, severity, nursing model change, safety, self-efficacy), and 20 secondary indicators. (5) the analysis of the results of the final scale. The total Cronbach' 伪 coefficient of the scale was 0.882. The exploratory factor analysis extracted 6 common factors, which was consistent with the six dimensions of the scale. The cumulative variance interpretation rate was 72.226, and the fitting of the confirmatory factor analysis model was as follows: 蠂 2 / df1.677, relative fitting index 0.936, Taker-Louis index 0.921, approximate error RMS 0.061, and good fit. The final scale has good reliability and validity. Conclusion: the stress assessment scale constructed in this study can reflect the psychological stress characteristics of the family members of patients with ICU transferred out of ICU after the expert consultation of Delphi method and the screening of pre-investigation items. The scale has good reliability and validity, which is suitable for the assessment of stress in the family members of ICU patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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